The impact of COVID-19 on the Child and Adolescent Psychiatric Emergency Departments of the paediatric university hospital in Brussels

Introduction Since the COVID-19 pandemic outbreak, children and adolescents mental health has been severely impacted. During the first lockdown measures in the spring of 2020, we observed a decrease in access to care, principally due to the “stay home” policy. From the beginning of the year 2021, we observed a massive increase in admission to the Child and Adolescent Psychiatry (CAP) Emergency Departments (ED) (Beaudry et al. Ann. Gen. Psychiatry 2022; 21(1), 17; Hernández-Calle et al. SJCAPP 2022; 10(1), 53–57). Objectives First, this study aimed to quantify the increase in patients’ admissions to the CAP ED of the paediatric university hospital in the urban area of Brussels. Second, we described the reasons for admission. Methods We conducted an observational retrospective study in the French-speaking Belgium paediatric university hospital in Brussels. Through the ED register, we selected all the admissions for psychiatric reasons from 1st December 2020 to 1st December 2021. Data were collected from patients’ electronic medical records and compared to data from 1st January 2013 to 29th February 2016, already collected in 2016 from the same ED. To compare the variables between 2013-2016 and 2020-2021, we performed a Student’s t-test for the number of admissions to CAP EP, a chi-squared test for sex rate, suicide attempts and urgent hospitalizations, and a Wilcoxon test for the median age. The study protocol was approved by the Queen Fabiola Children’s University Hospital IRB (reference 99/21). Results Female patients were more represented in 2020-2021 than in 2013-2016 (48% compared to 66.1%, p<0.001), and the median age increased from 12 to 14 y.o. (p<0.05). Compared to a few years before, we registered a 280.79% increase in the admissions to the CAP ED, resulting in 252 admissions in 38 months (2013-2016) compared to 303 in 12 months (2020-2021) (p<0.001). Admissions for suicidal attempts were twice higher than 2013-2016 (from 6.8% to 12.5%; p<0.001) and urgent hospitalizations increased eight times (from 0.8% to 6.7%; p<0.001). Admissions to the CAP ED started to decrease progressively during the whole year 2021, with the lowest peak during summer holidays (Fig.1). In 2013-2016, the 3 main reasons for admissions to the CAP ED were disruptive behaviors (15.1%), psychomotor agitation (14.2%) and somatic manifestations (12.3%); whereas in 2020-2021, these were suicidal ideations (14%), suicide attempts (12.5%) and somatic manifestations (10.4%). Figure 1 – Admissions to the CAP ED during 2020-2021, rates per month. Image: Conclusions According to our comparative study and the literature, admissions to the CAP ED increased significantly during the second wave of the COVID-19 pandemic, especially for suicidal ideations and suicide attempts. The urgent hospitalisations are eight times higher during the period 2020-2021. Disclosure of Interest None Declared

Introduction: Since the COVID-19 pandemic outbreak, children and adolescents mental health has been severely impacted.During the first lockdown measures in the spring of 2020, we observed a decrease in access to care, principally due to the "stay home" policy.From the beginning of the year 2021, we observed a massive increase in admission to the Child and Adolescent Psychiatry (CAP) Emergency Departments (ED) (Beaudry et al. Ann. Gen. Psychiatry 2022;21(1), 17;Hernández-Calle et al. SJCAPP 2022;10(1), 53-57).
Objectives: First, this study aimed to quantify the increase in patients' admissions to the CAP ED of the paediatric university hospital in the urban area of Brussels.Second, we described the reasons for admission.Methods: We conducted an observational retrospective study in the French-speaking Belgium paediatric university hospital in Brussels.Through the ED register, we selected all the admissions for psychiatric reasons from 1 st December 2020 to 1 st December 2021.Data were collected from patients' electronic medical records and compared to data from 1 st January 2013 to 29 th February 2016, already collected in 2016 from the same ED.To compare the variables between 2013-2016 and 2020-2021, we performed a Student's t-test for the number of admissions to CAP EP, a chi-squared test for sex rate, suicide attempts and urgent hospitalizations, and a Wilcoxon test for the median age.The study protocol was approved by the Queen Fabiola Children's University Hospital IRB (reference 99/21).Results: Female patients were more represented in 2020-2021 than in 2013-2016 (48% compared to 66.1%, p<0.001), and the median age increased from 12 to 14 y.o.(p<0.05).Compared to a few years before, we registered a 280.79% increase in the admissions to the CAP ED, resulting in 252 admissions in 38 months (2013-2016) compared to 303 in 12 months (2020-2021) (p<0.001).Admissions for suicidal attempts were twice higher than 2013-2016 (from 6.8% to 12.5%; p<0.001) and urgent hospitalizations increased eight times (from 0.8% to 6.7%; p<0.001).Admissions to the CAP ED started to decrease progressively during the whole year 2021, with the lowest peak during summer holidays (Fig. 1).In 2013-2016, the 3 main reasons for admissions to the CAP ED were disruptive behaviors (15.1%), psychomotor agitation (14.2%) and somatic manifestations (12.3%); whereas in 2020-2021, these were suicidal ideations (14%), suicide attempts (12.5%) and somatic manifestations (10.4%).).In the recent years, there is a growing interest in suicide prevention research in differentiating attempter profiles in terms of lifetime suicide attempts.Specifically, studies suggest that there may be meaningful differences concerning risk factors between patients with a history of one versus multiple suicide attempts.Multiple attempters (MA) show more suicidal ideation, depressive symptoms and hopelessness than single attempters (SA) (Esposito et al, 2003;Goldston et al, 1998).

Objectives:
We aimed to answer the question 'What are the factors associated with attempting suicide for the first time and are they different from the factors associated with re-attempting suicide in children and adolescents?' Methods: We conducted a systematic literature search in four databases.Article selection and data extraction according to a predefined protocol, including bias risk assessment, were performed by independent peer reviewers.Due to the different way to present data in the studies effect sizes were pre-calculated to standard mean differences (SMD).Random effects model was used to calculate the pooled effect size for all meta-analysis.Publication bias was assessed using funnel plots.Results: 14 studies were included in the systematic review, and 13 in the meta-analysis.Original articles used in the meta-analysis included a total of 4286 participants of whom 1579 were multiple suicide-attempters and 2707 single suicide attempters.MAs showed significantly higher proportion of anxiety disorders (SMD = 0.387, 95%CI [0.09, 0.68], p < 0.022), alcohol abuse disorder (SMD = 0.382, 95%CI [0.07, 0.70], p < 0.036) and substance abuse disorder (SMD = 0.526, 95%CI [0.21, 0.84], p <0.013) than SAs.Mean depression severity was higher among MAs than SAs (SMD = 0.515, 95%CI [0.17, 0.86], p < 0.011).MAs showed higher impulsivity (SMD = 0.28, 95%CI [-0.03, 0.60], p < 0.068) and aggressiveness (SMD = 0.688, 95%CI [0.42, 0.96], p < 0.00) than SAs.Hopelessness (SMD = 0.482, 95%CI [0.06, 0.91], p < 0.03) and suicidal ideation (SMD = 0.399, 95%CI [0.34, 0.46], p < 0.007) was significantly higher in MA.Conclusions: On the basis of the current results, multiple attempters may represent a distinct patient population in terms of being a more severe clinical profile.This can provide the basis of stronger suicide prevention and vigilance programs focused in this suicidal phenotype.

EPP0941
Analysis of self-esteem and body image in affective psychotic disorder with onset in adolescence S. Susana Perez* and I. Martin-Herrero Introduction: In schizoaffective disorder, treatment with atypical antipsychotics is a first-line treatment option associated with treatment with mood stabilizers.One of the associated adverse effects is weight gain, which is sometimes associated with a deterioration of self-image and greater psychosocial impact.Objectives: 1.To assess the personal perception and psychosocial adjustment in patients with affective psichotic disorder onset of symptoms in adolescence in current treatment with oral or IM aripiprazole.2. To determine if there is variation in self-perception in patients with oral treatment compared to patients with long-term injectable treatment Methods: Patients with affective psichotic disorder onset in adolescence come to consultation.Retrospective data collection: 9 months.Cross-sectional assessment with E-PICA scale.SPSS21.0.

Figure 1 -
Admissions to the CAP ED during 2020-2021, rates per month.
According to our comparative study and the literature, admissions to the CAP ED increased significantly during the second wave of the COVID-19 pandemic, especially for suicidal ideations and suicide attempts.The urgent hospitalisations are eight times higher during the period 2020-2021.Disclosure of Interest: None DeclaredEPP0940Factors associated with first suicide attempt vs. re-attempt in children and adolescents: A systematic review and meta-analysis Introduction: Suicide among children, adolescents and young adults is a major health problem, as it represents the fourth leading cause of death among people aged15-29 (WHO, 2022).A recent study showed that the years of potential life lost (YPLL) due to suicide in 2018 were 1,344,552, which is very close to the 1,591,487 YPLL caused by COVID-19 in the year 2020(Porras-Segovia et al,  2021